| Legacy Internal Medicine Llc | |
|
498 Wando Park Blvd Ste 500 Mount Pleasant SC 29464-7963 | |
| (843) 606-9199 | |
| (843) 718-2858 |
| Full Name | Legacy Internal Medicine Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 498 Wando Park Blvd Ste 500, Mount Pleasant, South Carolina |
| Authorized Official Name and Position | Tina Marie Botelho (PHYSICIAN) |
| Authorized Official Contact | 8436069199 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Internal Medicine Llc 498 Wando Park Blvd Ste 500 Mount Pleasant SC 29464-7963 Ph: (843) 606-9199 | Legacy Internal Medicine Llc 498 Wando Park Blvd Ste 500 Mount Pleasant SC 29464-7963 Ph: (843) 606-9199 |
| NPI Number | 1528345162 |
|---|---|
| Provider Enumeration Date | 11/10/2011 |
| Last Update Date | 01/21/2024 |
| Medicare PECOS PAC ID | 4688834336 |
|---|---|
| Medicare Enrollment ID | O20120404000638 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528345162 | NPI | - | NPPES |
| 253442 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Tina M Botelho |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023044245 PECOS PAC ID: 1456328749 Enrollment ID: I20040915000939 |
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